Individual-Level Interventions

1. Individual-Level Interventions EPHE 348

2. Interventions • Defn: promoting activities that change psychosocial, biological, or behavioural outcomes • Efficacy trials • Effectiveness trials

3. So….what works? • Average individual-level intervention effect is a small effect size (Dishman & Buckworth, 1996; Hillsdon et al., 2005; Kahn et al, 2002) • This lowers with clinical, obese, and disabled populations

4. Figure 17.2

5. Types of interventions • Behaviour modification (small effect) • Cognitive modification (trivial) • Health education (trivial) • Prescription (trivial) • Curriculum (small)

6. Implemetation • Marcus et al. 2007 show relatively little difference across medium (face to face, internet, booklet, group, etc.) • Face to face and internet have current appeal

7. What Generally Makes A Good Exercise Counselor? • Most important instrument during prescription is yourself as a person • Bring the human qualities and the exercise experiences that have influenced yourself to the session • Being merely a technical expert will result in a sterile experience for the client

8. General Exercise Counseling Roles • Provide a climate for change • Arrive at an prescription/intervention that is best for the client while meeting the requirements of the prescription • Help clients recognize their own strengths and weaknesses, and discover how to overcome their barriers

9. When Should You Counsel? • Counsel when the issues are linked to exercise or you have knowledge in the area of concern • Do not counsel when the area is out of your expertise (e.g., depression). Instead refer to a specialist

10. Decision-Making Paradigm

11. Counseling Strategies • Three components of Communication • Attending • awareness of nonverbal behavior • awareness of client’s nonverbal behavior • Listening • understanding feeling and content of verbal messages • identifying incongruities • Empathic Responding • showing Empathy • understanding core message

12. Attending:Nonverbal Behavior of the Counselor • Examples • squaring turning one’s body to fully focus attention. Failure to do so can reflect disinterest and lack of respect. • energy level –Absence of energy is frequently interpreted as a lack of interest or preoccupation. Presence of energy will directly affect the clients openness to you and also affects “approachability”.

13. Nonverbal Behavior of the Counselor Cont... • Posture – folded arms crossed legs, foot shaking. Can be signs of disinterest in the client or topic. • Eye contact – most common and powerful technique. In our society, steady eye contact reflects interest. • Others to watch are: facial expressions, gestures, voice volumes, mannerisms • Keep behavior congruent with the message!

14. Attending: Nonverbal Behavior of Clients • Often more significant than verbal communication • Conveys 65% of the meaning in a message (Gazda, 1984).Powerful because it is not as censored. • Look for incongruities (e.g., smiling with a nervous gesture)

15. Listening • Active listeners can accurately identify congruities and inconsistencies in verbal and nonverbal behavior • 5WH strategy “who” “what”, “when”, “where”, “why”, and “how”

16. Empathic Responding • Empathy – ability to understand the experience of another person from that person’s frame of reference • May be the most important factor for bringing about change (Rogers, 1957) • May need to paraphrase or perception check to make this work

17. Key to Exercise Counseling • Be aware of these strategies • Develop your own style

18. Exercise • Get into groups of three • Assign roles: • 1) client, 2) counselor, 3 observer • Client talks about what she/he has done over the past weekend and what she/he felt about it • Observer marks the use of counseling strategies by the counselor using the check list • Do for 5 minutes then switch roles….

19. Setting in Interventions • Home superior to Community-based (small effect size difference) – Rhodes et al., in press • School (small) • Worksite (small) • Health Care (small to trivial) • Multi-site may be most effective (McKay et al., in press)

20. Social Context • Group (ranges) • Individual (small) • Family (trivial) • Supervised (small) • Unsupervised (ranges)

21. Interventions by Theory Rhodes & Pfaeffli , in press

22. Results: Construct Evidence

23. Self-Regulatory Strategies: What Works? • 1) Planning- moving from vague intentions to concrete plans.. • When, where, how, and what • 2) Problem solving – identifying obstacles and creating alternative solutions

24. Goal Setting (Locke & Latham, 1981) • Technique that effectively increases performance in many domains • Goal – “attaining a specific standard of proficiency on a task, usually within a specified time limit” • 90% of studies have found this technique effective

25. How Does Goal Setting Work? • Directs attention to the task (allows for a map) • Prolongs effort over time (reviewing & revising goals) • Motivates the person to develop relevant strategies to attain the goals (breakdown of requirements)

26. The Findings in Goal Setting Research • Specific goals are more effective than general goals • Short term goals help attain long-term goals • Goal setting is most effective when feedback is provided • Goals need to be accepted by the client to be effective

27. How to Goal Set • 1) Specify the task to be done • 2) Determine how progress will be measured • 3) Specify the standard to be reached • 4) Specify the time period in which to reach the goal • 5) Prioritize goals • 6) Modify goals from time to time when necessary

28. SMART • Specific • Measurable/Meaningful • Attainable • Realistic • Time-Frame

30. Tangible Incentives • E.G., awards, time off, money etc. • Most people respond to this if the tangible incentive is sought by the individual • Caution: extrinsic factors should not replace intrinsic interest itself • Best strategy is to initiate with these and slowly drop them out of the program • Also must watch the “satiation factor”. A strategy is to use variable incentives